Agreement for Pre-Authorized
Credit Card Payments
USAA Savings Bank
P.O. Box 14050
Las Vegas, Nevada 89114-4050
STEP 1: Complete all required sections. Sign and date the document where indicated.
STEP 2: Return original document to USAA Federal Savings Bank and retain a copy for your records. It may
take up to 30 days for the bank to process this request.
STEP 3: Delivery Information to USAA
Fax to: 1-800-531-5717
Mail to: USAA Federal Savings Bank
Attn: Account Services
Attn: Account Services
10750 McDermott Freeway
San Antonio, Texas 78288-0596
Debit Authorization
A. Debit Authorization Information
I authorize USAA Savings Bank ("USAA") to initiate electronic debit entries to my deposit account with the
financial institution indicated below for the purpose of making payments on my USAA credit card or credit
line account. I understand the debit will occur each month on the due date shown on my statement for the
amount indicated below:
Choose the authorized monthly payment:
Minimum Payment Due
Statement Balance in Full
Fixed Payment of $
Credit Card Number (last four digits)
(or the minimum payment due if greater)
Minimum Payment Due
Statement Balance in Full
Fixed Payment of $
Credit Card Number (last four digits)
(or the minimum payment due if greater)
USAA Number
Funding Bank
Branch Location (if applicable)
Funding Bank Address
City
State
Bank Routing Number
Bank Account Number
ZIP Code
Funding Bank Telephone Number
Savings
Checking
Name of the Bank Account Holder
B. Agreement with USAA Savings Bank
I authorize USAA to make electronic withdrawals from and deposits to my account, as shown above, until I
revoke the authorization and USAA has time to act. I acknowledge that the origination of Automated
Clearing House (ACH) transactions in my account must comply with U.S. Law.
Name (please print)
USAA Savings Bank
Signature
Date
■ 1-800-531-USAA (8722)
■ Fax 1-800-531-5717
■ usaa.com
66270-0609
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